Maturity Matrices were adopted by the VFM Unit in NHS Wales in 1992 as a means of encouraging better practice in waiting times management. They were based on the instruments used by Post Office Counters and subsequently the Benchmarking Institute to assess benchmarking practice. Since then they have been used in many contexts such as patients charter, housing, hospital pharmacy, mental health, clinical pathways, mental health commissioning, patient safety and for organisational development guides (health authorities, clinical governance, business excellence). It has since been adopted in local government by the Wales Local Government Association Benchmarking Team; and also for facilities management in public services. For an early summary see ‘Benchmarking for best value in the NHS, J Bullivant, FT Healthcare, 1998, ISBN 1 860673 53 8) The format is consistent but the shape i.e. number of columns has varied. In a guide produced for Council for Health Service Accreditation of Southern Africa (Cohsasa) in 2002 the maturity matrix (MATMAT) was described as an instrument developed to measure outcome performance. ‘This is an innovative form of managing both soft and harder statistical data in a form which encourages

(a) honesty of response

(b) reflection on practice

(b) indication of otherwise good practice undermined by weakness in key areas

(d) ease of comparison between different sectors and levels of management

(e) opportunity for longitudinal surveys at limited cost’

A maturity matrix is a table which expresses in English the key elements of a topic and levels of performance or practice attained. The guide is elegant in usually consisting of only one double side of A4 with an introduction on side one and a matrix on side two. The matrix is explicit rather than prescriptive and is usually presented as below.

Maturity matrices provide a simple mechanism for recording in text the current and potential levels of performance management They can be used as a diagnostic tool (either self assessment or supported); as a benchmarking tool to allow comparison and as an organisational development process allowing individual and groups of organisations to better understand the business they are in, the performance to which they aspire and the levels they have achieved. The most widespread use has probably been the Integrated Governance Matrix which appeared at first as a 10 element three column matrix as an appendix to the DH IG guide (Integrated Governance Handbook, DH 2006, reprinted 2009). Users found the 3 elements as too narrow and the guide was developed as a 7/8 column matrix.

The guide includes the instruction: ‘identify with a circle the level you believe your organisation has reached and then draw an arrow to the right to the level you intend to reach in the next six months. O====>.’

When used in board development board members are encouraged to reflect on the level they believe the board has reached and then use the results as a discussion point to understand variation. The IG matrix was calibrated to roughly approximate Foundation Trust application requirements at level 4 except for element 8 ‘Selection, development review of Board members’ where it would be necessary to be at level 7 ‘Whole Board is recognised as adding value’

in 2010 GGI devised a model annual review programme for voluntary organisations. This promotes the common view (UK Corporate Governance Code, Monitor – now NHS Improvement, etc) that the Chairman should undertake an annual review of the performance of the Board. We devised an annual review maturity matrix which allows Chairs and Boards to clarify their development needs. The matrix encourages as a part of the normal annual cycle of business:

• An assessment by board members and senior officers of the current performance of the board
• A discussion and debate covering variations of view
• A consensus on the desired progress to be achieved over the next, say, six months
• A follow-up evaluation to measure how far they have progressed since the diagnostic stage.

In 2010 the GGI developed a instrument which combined the BAPs and maturity matrices in the Pathway Governance Guides No 2: Diabetes care. This is the second (the first was for community acquired pneumonia) in a series of guides targeted at NHS Board members and planners of health care improvement. It is intended to improve the quality of care by reducing variation and increasing reliability of timely, cost effective treatment when patients transfer from one part of the healthcare system to another.

The guide describes diabetes and the likely stages in a diabetes career if ignored. It suggests a series of questions that board members might ask to ensure that they are adopting strategies that will improve the reliability of care for people with diabetes, and that plans are in place to support members of the population at risk. It also includes a diabetes world class commissioning maturity matrix covering outcomes, competencies, governance, strategy and organisational development.